HEPARIN INDUCED THROMBOCYTOPENIA NEJM PDF

Anti–platelet factor 4–heparin antibodies present a major risk of heparin-induced thrombocytopenia (HIT). The use of intravenous immune. A new Clinical Practice article provides an overview of heparin induced thrombocytopenia. HIT is characterized by a platelet count fall of more. Correspondence from The New England Journal of Medicine — Heparin-Induced Thrombocytopenia Associated with Fondaparinux.

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Antithrombotic therapy is required to manage heparin-induced thrombocytopenia HITbut currently approved agents such as argatroban must be given parenterally and closely monitored. To address this question, investigators at McMaster University in Canada examined their own experience and conducted a systematic review of the literature regarding the use of DOACs for initial treatment of acute HIT as well as after other primary therapies.

Rivaroxaban was the primary therapy heparij 25 of 46 patients; only one of the 46 had progression of thrombosis, and none had major bleeding.

A total of 12 patients received apixaban and 11 received dabigatran, generally after another primary therapy. Of these 23 patients, only one had a thrombotic event and none had major bleeding.

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Because observational studies such as those reported here might be biased by patient selection, randomized trials that compare Heparon with either argatroban or fondaparinux are urgently needed. For the present, clinicians might consider prescribing a DOAC for acute HIT and tailoring the dose and duration of treatment for each patient. Warkentin TE et al. Direct oral anticoagulants for treatment of HIT: Update of Hamilton experience and literature review.

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CLINICAL PRACTICE. Heparin-Induced Thrombocytopenia.

Venous thromboembolism occurred less frequently with the direct oral anticoagulant apixaban than with placebo. Gradishar, MD Highlights of the latest research. Genetic Testing for Breast Cancer: How Effective Are Guidelines?

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J Clin Oncol Dec 7 National Comprehensive Cancer Network guidelines for multigene panel testing miss nearly half of patients with actionable variants. Gradishar, MD A perspective on the most important research in the field from the past year. N Engl J Med Dec 1 Older patients with previously untreated disease had better outcomes with ibrutinib than with chemo-immunotherapy. Blood Dec 3 Ravulizumab was noninferior to eculizumab in both previously treated and treatment-naive patients.

N Engl J Med Dec 1 Forty percent of patients with relapsed or refractory disease achieved complete remission. N Engl J Med Dec 13 At 23 years of follow-up, life expectancy was nearly 3 years longer with inducd than with watchful waiting. N Engl J Med Dec 4 Venous thromboembolism occurred less frequently with the direct oral anticoagulant apixaban than with placebo.

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